WORCESTER – Garry Levitsky is a familiar sight behind the counter at Beacon Pharmacy on Main Street.
This is a labor of love for Levitsky, as he has worked there as a pharmacist for more than 50 years and his family has run the pharmacy for more than 80 years. This range represents a long-term investment in the Main South neighborhood.
But when it came to the topic of naloxone, Levitsky's expression became animated as he talked about the nasal spray, known by the brand name Narcan, that reverses the potentially life-threatening effects of an opioid overdose.
Levistsky said that while the opioid crisis has hit the area around his store, he has never refused Narcan to anyone who ran into his store saying they needed it in an emergency. Ta. Nor did he ask the afflicted person to pay for it. “I've given Narcan many, many times. I've never turned anyone away in an emergency,” he said.
Narcan is stored behind the counter at Beacon Pharmacy. Each box contains two doses of spray and each box costs about $60. Levitsky said his business has standing orders from the state to sell drugs.
The standing order went into effect statewide in 2018 to combat the opioid crisis. This meant that all pharmacies could sell naloxone without a prescription to people at risk of overdosing. It can be purchased by anyone who wants to carry the drug with them to administer in an emergency.
But because the drug was kept behind the counter, it appears standing orders may have restricted its sale to those most at risk of drug overdose. Customers had to request it and provide personal information at the time of sale. The stigma associated with drug use could then deter sales.
Naloxone approved as an over-the-counter drug
Then the U.S. Food and Drug Administration stepped in and approved over-the-counter sales of 4-milligram doses of naloxone in March. Like cold and flu medicine, the FDA's decision meant naloxone was sold out on the counter. It is thought that more people at risk of overdosing would buy drugs if they could buy them anonymously without having to go to the counter and ask for them.
The FDA's goal was to increase access to this drug and save lives across the United States. But are Massachusetts and Worcester achieving that goal?
Not all pharmacy shelves have naloxone
A random sample of Worcester's independent and chain pharmacies conducted by the Telegram and Gazette found significant differences in how naloxone is sold. Of the seven pharmacies visited by T&G, only one sold Narcan on the shelf, and that was a Walmart Supercenter.
Meanwhile, the state Department of Public Health memo Last month, we encouraged all retailers in Massachusetts to make Narcan more prominent in their stores. Health officials want drugs to be displayed at the front of stores and in front of cash registers, rather than behind counters or locked in cabinets where customers have to request them. The goal is to purchase Narcan anonymously so that the stigma of drug use does not prevent access to Narcan.
Making Narcan more visible in pharmacies is supported by Paul Hattis, a senior fellow at the Roan Institute, a nonpartisan medical think tank. “I support the desire to make Narcan more available to people who could potentially save their lives by administering it,” he said.
The Massachusetts Pharmacists Association did not respond to a request for comment, and the Central Massachusetts Health Foundation said it could not comment on the matter. Massachusetts Memorial Hospital declined a request for an interview with Dr. Kavita Babu, the health system's chief opioid officer.
A pharmacist explains the sales method
In addition to the independent Beacon Pharmacy and Walmart Supercenter, other pharmacies visited by T&G included two independent stores: Worcester Pharmacy on Southbridge Street and Boulevard Pharmaceutical Compound Center on Shrewsbury Street. I was there. Other commercial pharmacies visited include the Walgreens at Park Avenue and Chandler Street, and his two CVS pharmacies at 500 Grafton Street and 44 West Boylston Street.
Some pharmacists at these locations explained how naloxone is sold in their stores. Ahmad Eljarush, a pharmacist at Worcester Pharmacy, said the business is under a permanent order from the state to keep Narcan behind the counter. Customers must request it, and personal information is only required when purchasing drugs with insurance.
El Jaroush said Worcester Pharmacy stores Narcan behind the counter so staff can make sure customers know how to use the medication. Like Levitsky at Beacon Pharmacy, El Jaroush said customers who need medication in an emergency can get it immediately and free of charge.
The pharmacy sells two-dose boxes of Narcan for $75, but sales have not been strong, with an average of four sales per month, El-Jaroush said.
At Walgreens, $49.99 Narcan was available behind the pharmacy counter and in the front of the store. Walgreens did not respond to a request for comment.
The Narcan was stored in a locked cabinet at the CVS in the 500 block of Grafton Street, and each box was sold for $44.99. One store pharmacist said she was concerned about the possibility of theft and had not yet seen state guidelines encouraging retailers to keep Narcan outdoors.
Employees at the CVS at 44 West Boylston Street didn't know where Narcan was, so they had to ask the store manager to find it. Instead of drugs on the shelves, the manager showed customers a stack of cards directing customers to the front register to buy drugs.
“CVS Pharmacy stores, including those in Massachusetts, have a sufficient supply of over-the-counter Narcan,” CVS said in the email. The drug is stocked at store registers and is also readily available on over-the-counter shelves near pharmacies, the company said.
At Boulevard Pharmaceutical Compounding Center, which makes custom medications, pharmacist and owner Cal Bukatem said he doesn't sell over-the-counter medications because his store doesn't have a walk-in business.
But Bukatem went back behind the counter and returned with a box containing two doses of Narcan nasal spray. Massachusetts Board of Pharmacy Registration inspectors require pharmacies to carry Narcan, Bukatem said.
Bukatem is concerned about Worcester's sizable low-income community, which may not be able to afford Narcan. “We need to look at the cost…It's good to make it affordable to the public,” he said.
If someone were to come into his store in a panic and ask for Narcan, Bukatem said, I do not have any questions. ”
Free Narcan widely available
Meanwhile, more than 86,000 free naloxone kits were distributed in Massachusetts last year through the state's community naloxone program, according to the state Department of Public Health. The agency said the free kits have helped reverse at least 2,600 overdoses.
In Worcester, free Narcan is available through boxes called NaloBoxes placed in municipal buildings and social service agencies throughout the city. A total of 20 boxes were installed, including one box on the first floor of City Hall. Each NaloBox contains two boxes of Narcan, and each two boxes contain 12 doses of the drug.
A city spokesperson said 11 more NaloBoxes will be installed in city buildings and local agencies.
Contact Henry Schwan at [email protected]. Follow him on X: @henrytelegram.
